Use of ultrasound for hardware removal. / La ecografía como herramienta para la extracción de material de osteosíntesis.

INTRODUCTION: Osteosynthesis hardware removal is one of the most frequent practices in Orthopedic electives surgeries and is usually carried out guided under fluoroscopy. There are other tools such as ultrasound that allow us to visualize the hardware with the advantage of being free of ionizing radiation and with better availability. The objective of our study is to analyze the results obtained in patients undergoing hardware removal in the operating room under ultrasound assistance and local anesthesia. MATERIAL AND METHODS: A descriptive study was carried out collecting variables such as demographic data, reason for the removal, pain during the procedure and in subsequent days, as well as the duration and rate of success of the procedure and the degree of satisfaction. RESULTS: We obtained a 100% success in ultrasound-guided extraction without the need for conventional radiology, with a mean VAS of 1.91 and need for subsequent analgesia in 36.4% of the cases, with syndesmotic dynamization being the most frequent reason for intervention. CONCLUSION: Ultrasound is a useful tool in osteosynthesis hardware removal, and that may be sufficient by itself; also saving health personnel and patients from ionizing radiation resulting from the use of conventional fluoroscopy.

Validation of circulating microRNAs miR-142-3p and miR-598-3p in women with polycystic ovary syndrome as potential diagnostic markers.

STUDY QUESTION: Circulating miRNAs previously associated with androgen excess in women might be used as diagnostic biomarkers for polycystic ovary syndrome (PCOS). SUMMARY ANSWER: Models based on circulating miR-142-3p and miR-598-3p expression show good discrimination among women with and without PCOS, particularly when coupled with easily available measurements such as waist-to-hip ratio (WHR) and circulating LH-to-FSH (LH/FSH) ratios. WHAT IS KNOWN ALREADY: The lack of standardization of the signs, methods, and threshold values used to establish the presence of the diagnostic criteria (hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology) complicates the diagnosis of PCOS. Certain biomarkers may help with such a diagnosis. We conducted a validation study to check the diagnostic accuracy for PCOS of several miRNAs that were associated with the syndrome in a small pilot study that had been previously carried out by our research group. STUDY DESIGN, SIZE, DURATION: This was a diagnostic test study involving 140 premenopausal women. PARTICIPANTS/MATERIALS, SETTING, METHODS: We included 71 women with PCOS and 69 healthy control women in the study. Both groups were selected as to be similar in terms of body mass index. We used miRCURY LNA™ Universal RT microRNA PCR to analyse the five miRNAs that had shown the strongest associations with PCOS in a much smaller pilot study previously conducted by our group. We studied diagnostic accuracy using receiver operating characteristics (ROC) curve analysis. MAIN RESULTS AND THE ROLE OF CHANCE: Only the expression of two miRNAs, miR-142-3p and miR-598-3p, of the five studied, was different between the women with PCOS and the non-hyperandrogenic controls. The diagnostic accuracy of the combination of these circulating miRNAs was good (area under the ROC curve (AUC) 0.801; 95% CI: 0.72-0.88) and was further improved when adding WHR (AUC 0.834, 95% CI: 0.756-0.912), LH/FSH ratio (AUC = 0.869, 95% CI: 0.804-0.934) or both (AUC = 0.895, 95% CI: 0.835-0.954). We developed several models by selecting different threshold values for these variables favouring either sensitivity or specificity, with positive and negative predictive values as high as 88% or 85%, respectively. LIMITATIONS, REASONS FOR CAUTION: Patients included here had the classic PCOS phenotype, consisting of hyperandrogenism and ovulatory dysfunction; hence, the present results might not apply to milder phenotypes lacking androgen excess. WIDER IMPLICATIONS OF THE FINDINGS: If confirmed in larger studies addressing different populations and PCOS phenotypes, these biomarkers may be useful to simplify the clinical diagnosis of this prevalent syndrome. STUDY FUNDING/COMPETING INTEREST(S): This research was funded by Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation (grants PI15/01686, PIE16/00050, PI18/01122 & PI21/00116) and co-funded by European Regional Development Fund 'A way to make Europe'. Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM) and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) are also initiatives of the Instituto de Salud Carlos III. The authors have no competing interests to disclose. TRIAL REGISTRATION NUMBER: N/A.

Resultados funcionales tras hemiartroplastía de hombro por fractura de húmero proximal: experiencia en nuestro centro / Functional results after shoulder hemiarthroplasty for proximal humerus fracture: experience in our center

Resumen: Introducción: la hemiartroplastía de hombro está siendo relegada como tratamiento de fracturas de húmero proximal no osteosintetizables. Nuestro objetivo es analizar los resultados funcionales de los pacientes tratados con hemiartroplastía por este motivo en nuestro centro. Material y métodos: estudio descriptivo transversal que incluye a los pacientes intervenidos entre Febrero de 2016 y Noviembre de 2021; 24 pacientes, con un seguimiento medio de 44.6 meses. Fueron recogidos el balance articular activo, el test de Constant-Murley, el cuestionario DASH y el dolor actual (EVA). Como parámetros radiográficos se analizó el número de fragmentos de fractura y la consolidación de las tuberosidades. Resultados: se obtuvo una media de 71.65 ± 13.75 en el Constant-Murley y de 18.14% ± 13.92 en el DASH. Para flexión de hombro la media fue de 108.75o ± 41.26; 104.5o ± 43.68 para abducción y 33o ± 14.73 para rotación externa. En rotación interna 60% llegaba hasta plano interescapular. EVA medio de 1.25 ± 1.74. Tuberosidades consolidadas en 90.5%. No hubo diferencias significativas entre el Constant-Murley, DASH ni rotaciones de pacientes mayores y menores de 65 años. Los mayores de 65 años obtuvieron flexión media de 125.91o ± 26.82 y los menores de 87.78o ± 26.82 (p = 0.038). La abducción media en mayores de 65 fue de 125.45 ± 28.94 versus 78.89 ± 46.29 en el grupo joven (p = 0.012). Conclusión: la hemiartroplastía otorga calidad de vida con aceptable funcionalidad y buen control del dolor, por lo que debe continuar siendo una alternativa a tener en cuenta en pacientes seleccionados.

Abstract: Introduction: shoulder hemiarthroplasty is being relegated as a treatment for non-osteosynthetic proximal humerus fractures. Our objective is to analyze the functional results of patients treated with hemiarthroplasty for this reason in our hospital. Material and methods: cross-sectional descriptive study that includes patients operated between February 2016 and November 2021; 24 patients, with an average follow-up of 44.6 months. Active joint balance, the Constant-Murley test, the DASH questionnaire and current pain (VAS) were collected. The radiographic parameters analyzed were the number of fracture fragments and the consolidation of the tuberosities. Results: a mean of 71.65 ± 13.75 was obtained in the Constant-Murley and 18.14% ± 13.92 in the DASH. For shoulder flexion, the mean was 108.75o ± 41.26; 104.5o ± 43.68 for abduction and 33o ± 14.73 for external rotation. About internal rotation, 60% of the patients reached the scapular plane. Average VAS was 1.25 ± 1.74. Consolidated tuberosities in 90.5%. There were no significant differences comparing the Constant-Murley test, DASH or rotations between both, over and under 65 years old group of patients. Those over 65 years of age obtained a mean flexion of 125.91o ± 26.82 whereas those under 87.78o ± 26.82 (p = 0.038). The mean abduction in those over 65 was 125.45 ± 28.94 vs 78.89 ± 46.29 in the young group (p = 0.012). Conclusion: hemiarthroplasty provides quality of life with acceptable functionality and good pain control, therefore it should continue to be an alternative to consider in selected patients.

Lithium salts as a treatment for COVID-19: Pre-clinical outcomes.

INTRODUCTION: Identifying effective drugs for Coronavirus disease 2019 (COVID-19) is urgently needed. An efficient approach is to evaluate whether existing approved drugs have anti-SARS-CoV-2 effects. The antiviral properties of lithium salts have been studied for many years. Their anti-inflammatory and immune-potentiating effects result from the inhibition of glycogen synthase kinase-3. AIMS: To obtain pre-clinical evidence on the safety and therapeutic effects of lithium salts in the treatment of COVID-19. RESULTS: Six different concentrations of lithium, ranging 2-12 mmol/L, were evaluated. Lithium inhibited the replication of SARS-CoV-2 virus in a dose-dependent manner with an IC50 value of 4 mmol/L. Lithium-treated wells showed a significantly higher percentage of monolayer conservation than viral control, particularly at concentrations higher than 6 mmol/L, verified through microscopic observation, the neutral red assay, and the determination of N protein in the supernatants of treated wells. Hamsters treated with lithium showed less intense disease with fewer signs. No lithium-related mortality or overt signs of toxicity were observed during the experiment. A trend of decreasing viral load in nasopharyngeal swabs and lungs was observed in treated hamsters compared to controls. CONCLUSIONS: These results provide pre-clinical evidence of the antiviral and immunotherapeutic effects of lithium against SARS-CoV-2, which supports an advance to clinical trials on COVID-19's patients.

[Functional results after shoulder hemiarthroplasty for proximal humerus fracture: experience in our center]. / Resultados funcionales tras hemiartroplastía de hombro por fractura de húmero proximal: experiencia en nuestro centro.

INTRODUCTION: shoulder hemiarthroplasty is being relegated as a treatment for non-osteosynthetic proximal humerus fractures. Our objective is to analyze the functional results of patients treated with hemiarthroplasty for this reason in our hospital. MATERIAL AND METHODS: cross-sectional descriptive study that includes patients operated between February 2016 and November 2021; 24 patients, with an average follow-up of 44.6 months. Active joint balance, the Constant-Murley test, the DASH questionnaire and current pain (VAS) were collected. The radiographic parameters analyzed were the number of fracture fragments and the consolidation of the tuberosities. RESULTS: a mean of 71.65 ± 13.75 was obtained in the Constant-Murley and 18.14% ± 13.92 in the DASH. For shoulder flexion, the mean was 108.75° ± 41.26; 104.5° ± 43.68 for abduction and 33° ± 14.73 for external rotation. About internal rotation, 60% of the patients reached the scapular plane. Average VAS was 1.25 ± 1.74. Consolidated tuberosities in 90.5%. There were no significant differences comparing the Constant-Murley test, DASH or rotations between both, over and under 65 years old group of patients. Those over 65 years of age obtained a mean flexion of 125.91° ± 26.82 whereas those under 87.78° ± 26.82 (p = 0.038). The mean abduction in those over 65 was 125.45 ± 28.94 vs 78.89 ± 46.29 in the young group (p = 0.012). CONCLUSION: hemiarthroplasty provides quality of life with acceptable functionality and good pain control, therefore it should continue to be an alternative to consider in selected patients.

INTRODUCCIÓN: la hemiartroplastía de hombro está siendo relegada como tratamiento de fracturas de húmero proximal no osteosintetizables. Nuestro objetivo es analizar los resultados funcionales de los pacientes tratados con hemiartroplastía por este motivo en nuestro centro. MATERIAL Y MÉTODOS: estudio descriptivo transversal que incluye a los pacientes intervenidos entre Febrero de 2016 y Noviembre de 2021; 24 pacientes, con un seguimiento medio de 44.6 meses. Fueron recogidos el balance articular activo, el test de Constant-Murley, el cuestionario DASH y el dolor actual (EVA). Como parámetros radiográficos se analizó el número de fragmentos de fractura y la consolidación de las tuberosidades. RESULTADOS: se obtuvo una media de 71.65 ± 13.75 en el Constant-Murley y de 18.14% ± 13.92 en el DASH. Para flexión de hombro la media fue de 108.75° ± 41.26; 104.5° ± 43.68 para abducción y 33° ± 14.73 para rotación externa. En rotación interna 60% llegaba hasta plano interescapular. EVA medio de 1.25 ± 1.74. Tuberosidades consolidadas en 90.5%. No hubo diferencias significativas entre el Constant-Murley, DASH ni rotaciones de pacientes mayores y menores de 65 años. Los mayores de 65 años obtuvieron flexión media de 125.91° ± 26.82 y los menores de 87.78° ± 26.82 (p = 0.038). La abducción media en mayores de 65 fue de 125.45 ± 28.94 versus 78.89 ± 46.29 en el grupo joven (p = 0.012). CONCLUSIÓN: la hemiartroplastía otorga calidad de vida con aceptable funcionalidad y buen control del dolor, por lo que debe continuar siendo una alternativa a tener en cuenta en pacientes seleccionados.

Smart contact lens: A promising therapeutic tool in aniridia.

OBJECTIVE: The perform pre-clinical testing using optical design tools to simulate the optical quality of a smart artificial iris platform encapsulated in a scleral contact lens. These tools allow us to generate aniridia eye models and evaluate different metrics of visual quality and retinal illumination based on the aperture of the artificial iris based on liquid crystals. METHOD: The OCT imaging technique was used to measure the geometry of the anterior segment in a patient with aniridia and, from these data, the eye model was generated with the Zemax optical design program and specific programs developed in Matlab. Ocular aberrations were calculated and the visual function of the anirida eye model was evaluated in three scenarios: (i) without optical correction, (ii) with correction with a commercial scleral contact lens, and (iii) with correction with an optical lens. Intelligent contact based on artificial iris. RESULTS: Optical quality in patients with aniridia is limited by the magnitude of high-order aberrations. Conventional scleral contact lens design accurately corrects for blur but is unable to compensate for high-order ocular aberrations, especially spherical aberrations. The artificial iris-based smart contact lens design enables virtually all high-order aberrations to be compensated with active control of the pupillary diameter (activation of liquid crystal cells based on ambient lighting). In addition to minimizing high-order aberrations, reducing the pupil size would increase the depth of focus. CONCLUSIONS: This article demonstrates by means of optical simulations the concept of an intelligent artificial iris platform encapsulated in a scleral contact lens and its possible application in patients with aniridia. Furthermore, it allows us to anticipate possible visual results in clinical trials with healthy patients (after application of mydriatic agents) and in patients with aniridia. The results demonstrate a better visual quality and a decrease in retinal illumination.

[Adherence to pulmonary rehabilitation: An exploratory review]. / La adherencia a los tratamientos de rehabilitación pulmonar: revisión exploratoria.

Currently, several studies have identified low adherence to pulmonary rehabilitation in patients with COPD, despite the positive effects of the treatment. Patient adherence to pulmonary rehabilitation is affected by factors such as the absence of family support, and the presence of multiple comorbidities, respiratory distress, anxiety and depression. Given that there is no conclusive evidence about which of these factors are most influential in determining adherence to pulmonary rehabilitation in patients with COPD, we conducted this scoping review to analyse the available evidence on the factors influencing the adherence of patients with COPD to pulmonary rehabilitation programs (PRP). A wide literature search was carried out in Medline, Ovid, Science Direct, EMBASE, EBSCO and ISI-web of science, with prior definition of the selection criteria that included the factors associated with healthcare and adherence in patients with COPD in PRP. We used the adherence model proposed by the WHO as a conceptual framework. As a significant result, we found that factors in the dimension of illness (40%) and patient (30%) were the most frequently found dimensions in the studies, revealing that the design of pulmonary rehabilitation programs must take into account the specific needs of the patient. Further studies are needed to establish barriers and facilitators of adherence among COPD patients to PRP in the Colombian setting.

Smart contact lens: a promising therapeutic tool in aniridia. / Lente de contacto inteligente: una prometedora herramienta terapéutica en aniridia.

OBJECTIVE: To perform pre-clinical testing using optical design tools to simulate the optical quality of a smart artificial iris platform encapsulated in a scleral contact lens. These tools allow us to generate aniridia eye models and evaluate different metrics of visual quality and retinal illumination based on the aperture of the artificial iris based on liquid crystals. METHOD: The OCT imaging technique was used to measure the geometry of the anterior segment in a patient with aniridia and, from these data, the eye model was generated with the Zemax optical design program and specific programs developed in Matlab. Ocular aberrations were calculated and the visual function of the anirida eye model was evaluated in three scenarios: (i) without optical correction, (ii) with correction with a commercial scleral contact lens, and (iii) with correction with an optical lens. intelligent contact based on artificial iris. RESULTS: Optical quality in patients with aniridia is limited by the magnitude of high-order aberrations. Conventional scleral contact lens design accurately corrects for blur but is unable to compensate for high-order ocular aberrations, especially spherical aberrations. The artificial iris-based smart contact lens design enables virtually all high-order aberrations to be compensated with active control of the pupillary diameter (activation of liquid crystal cells based on ambient lighting). In addition to minimizing high-order aberrations, reducing the pupil size would increase the depth of focus. CONCLUSIONS: This article demonstrates by means of optical simulations the concept of an intelligent artificial iris platform encapsulated in a scleral contact lens and its possible application in patients with aniridia. Furthermore, it allows us to anticipate possible visual results in clinical trials with healthy patients (after application of mydriatic agents) and in patients with aniridia. The results demonstrate a better visual quality and a decrease in retinal illumination.

Review of Calomutilla Mickel, 1952, a new species, and comparison with Pertyella Mickel, 1952 (Hymenoptera: Mutillidae).

Calomutilla panamensis Cambra, Brothers Quintero sp. nov., female and male from Panama and Venezuela, and the hitherto unknown male of Calomutilla crucigera (Burmeister, 1854), are described and illustrated. Calomutilla panamensis represents the northernmost distribution record of this Neotropical genus and the first record from Venezuela. A key to species, photographs of the types of most species, and a brief description about the mating behavior of C. panamensis are presented. The differentiation of Calomutilla and Pertyella Mickel, 1952 is discussed and illustrated for both sexes.

Effect of supplementation with vitamins D3 and K2 on undercarboxylated osteocalcin and insulin serum levels in patients with type 2 diabetes mellitus: a randomized, double-blind, clinical trial.

BACKGROUND: Patients with type 2 diabetes mellitus (T2DM) are characterized by chronic hyperglycemia as a consequence of decreased insulin sensitivity, which contributes to bone demineralization and could also be related to changes in serum levels of osteocalcin and insulin, particularly when coupled with a deficiency in the daily consumption of vitamins D3 and K2. The objective of this study was to evaluate the effect of vitamin D3 and vitamin K2 supplements alone or in combination on osteocalcin levels and metabolic parameters in patients with T2DM. METHODS: A double-blind, randomized clinical trial was carried out in 40 patients aged between 30 and 70 years old for 3 months. Clinical and laboratory assessment was carried out at the beginning and at the end of the treatment. The patients were divided into three groups: (a) 1000 IU vitamin D3 + a calcinated magnesium placebo (n = 16), (b) 100 µg of Vitamin K2 + a calcinated magnesium placebo (n = 12), and (c) 1000 IU vitamin D3 + 100 µg vitamin K2 (n = 12). RESULTS: After treatment in the total studied population, a significant decrease in glycemia (p = 0.001), HOMA-IR (Homeostatic model assessment-insulin resistance) (p = 0.040), percentage of pancreatic beta cells (p < 0.001), uOC/cOC index and diastolic blood pressure (p = 0.030) were observed; in vitamin D3 group, differences in serum undercarboxylated osteocalcin (p = 0.026), undercarboxylated to carboxylated osteocalcin index (uOC/cOC) (p = 0.039) glucose (p < 0.001) and  % of functional pancreatic beta cells (p < 0.001) were demonstrated. In vitamin K2 group a significant decrease in glycemia (p = 0.002), HOMA-IR (p = 0.041), percentage of pancreatic beta cells (p = 0.002), and in cOC (p = 0.041) were observed, conversely cOC concentration was found high. Finally, in the vitamins D3 + K2 a significant decrease in glycemia (p = 0.002), percentage of pancreatic beta cells (p = 0.004), and in the uOC/cOC index (p = 0.023) were observed. CONCLUSION: Individual or combined supplementation with vitamins D3 and K2 significantly decreases the glucose levels and  % of functional pancreatic beta cells, while D3 and D3 + K2 treatments also induced a reduction in the uOC/cOC index. Only in the group with vitamin D3 supplementation, it was observed a reduction in undercarboxylated osteocalcin while vitamin K2 increased the carboxylated osteocalcin levels.Trial registration NCT04041492.

[Hypothalamotomy in patients with treatment-resistant aggressiveness: functional outcomes]. / Hipotalamotomía en pacientes con agresividad refractaria: resultados funcionales.

INTRODUCTION: Aggressiveness is part of the behavioural manifestations associated with some mental disorders; it is a symptom that is difficult to manage and is often resistant to pharmacological measures. Surgery for behavioural disorders emerges as a therapeutic alternative. This procedure consists in performing interventions on different structures of the limbic system in order to correct the alteration of the circuit involved in producing the symptoms. AIM: To describe the clinical outcomes of a posterior hypothalamotomy with gamma knife to control aggressiveness in 20 patients resistant to treatment, who underwent surgery at the Imbanaco Medical Centre between 2013 and 2018. PATIENTS AND METHODS: The severity of the aggressiveness was quantified using the Overt Aggression Scale (OAS) and the Clinical Global Impression Scale (CGI-SI), and its functional impact is evaluated using the Global Assessment of Functioning scale (GAF). RESULTS: Control over aggressiveness was observed in all patients treated by posterior hypothalamotomy with gamma knife, evidenced by a decrease in the scores on the OAS and CGI-SI and an improvement in the GAF. CONCLUSIONS: Posterior hypothalamotomy gives rise to few complications, is a safe procedure and offers good results, suggesting that it could be a good alternative treatment in cases of treatment-resistant aggressiveness where it seems that all the possible pharmacological and therapeutic measures have failed.

TITLE: Hipotalamotomía en pacientes con agresividad refractaria: resultados funcionales.Introducción. La agresividad forma parte de las manifestaciones comportamentales asociadas a algunos trastornos mentales, es un síntoma de difícil manejo y, con frecuencia, es refractaria a las medidas farmacológicas. La cirugía de los trastornos del comportamiento surge como una alternativa terapéutica. Este procedimiento consiste en realizar intervenciones sobre distintas estructuras del sistema límbico, con el fin de corregir la alteración del circuito que estaría implicado en la producción de los síntomas. Objetivo. Describir los resultados clínicos de la hipotalamotomía posterior con gamma knife en el control de la agresividad en 20 pacientes refractarios al tratamiento, intervenidos en el Centro Médico Imbanaco entre 2013 y 2018. Pacientes y métodos. La gravedad de la agresividad se cuantificó mediante la escala de agresividad manifiesta (OAS) y la escala de impresión clínica global (CGI-SI), y su impacto funcional, a través de la escala de evaluación de la actividad global (EEAG). Resultados. El control de la agresividad se observó en todos los pacientes tratados con hipotalamotomía posterior con gamma knife, evidenciado por la disminución en las puntuaciones de la OAS y la CGI-SI y la mejoría en la EEAG. Conclusiones. La hipotalamotomía posterior muestra bajas complicaciones, seguridad en el procedimiento y buenos resultados, lo cual sugiere que podría ser una buena alternativa de tratamiento en los casos de agresividad refractaria donde las medidas farmacológicas y terapéuticas parecen agotarse.

Effect and associated factors of a clinical pharmacy model in the incidence of medication errors (EACPharModel) in the Hospital Pablo Tobón Uribe: study protocol for a stepped wedge randomized controlled trial (NCT03338725).

BACKGROUND: According to WHO, medication error (ME) is a subject that requires attention at all levels of care to reduce severe and preventable damage related to medication use. Clinical pharmacy practice standards have been proposed around the world so that the pharmacist, as part of a multidisciplinary health team, can help improve patient safety; however, further evidence derived from adequate studies is needed to demonstrate this. This study aims to assess the effect of a clinical pharmacy practice model (CPPM) in preventing MEs associated with the medication use process. METHODS: A prospective, stepped-wedge, cluster-randomized, controlled trial with a duration of 14 months will be performed to compare the effect of a CPPM along with the usual care process of patients in the Pablo Tobón Uribe Hospital (Medellin, Colombia). The study is designed as a cluster-randomized controlled trial, involving five hospital wards (clusters) and 720 patients. Medical wards are allocated to interventions using a stepped-wedge design. Clusters are initially assigned to the control group. After a 2-month observation period, hospital clusters were randomly allocated to the intervention group. Study outcomes will be assessed at baseline and at 2, 4, 6, 8, 10, and 12 months after randomization. The primary outcome will be to assess the effect of a CPPM on the incidence of medication errors associated with the medication use process. Drug-related problems and factors that contribute to the occurrence of MEs will be assessed as secondary outcomes. Statistical analyses will be performed using a mixed model, with the treatment group and time as fixed effects and the clustering structure as a random effect. Statistical analysis will be performed using Pearson chi-square tests and Student's t-tests, and a P value < 0.05 will be considered statistically significant. DISCUSSION: As far as we know, this is the first stepped-wedge, cluster-randomized, controlled trial designed to assess the change of a CPPM on the incidence of medication errors in a hospital in Colombia, and it could generate valuable information about a standardized and patient-centered clinical pharmacy model to improve the safety of inpatient care. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03338725. Registered on 9 November 2017. The first patient was randomized on 2 February 2018. PROTOCOL VERSION: 0010112018JG.

Calibration of a thermoluminescent dosimeter worn over lead aprons in fluoroscopy guided procedures.

Fluoroscopy guided interventional procedures provide remarkable benefits to patients. However, medical staff working near the scattered radiation field may be exposed to high cumulative equivalent doses, thus requiring shielding devices such as lead aprons and thyroid collars. In this situation, it remains an acceptable practice to derive equivalent doses to the eye lenses or other unprotected soft tissues with a dosimeter placed above these protective devices. Nevertheless, the radiation backscattered by the lead shield differs from that generated during dosimeter calibration with a water phantom. In this study, a passive personal thermoluminescent dosimeter (TLD) was modelled by means of the Monte Carlo (MC) code Penelope. The results obtained were validated against measurements performed in reference conditions in a secondary standard dosimetry laboratory. Next, the MC model was used to evaluate the backscatter correction factor needed for the case where the dosimeter is worn over a lead shield to estimate the personal equivalent dose H p (0.07) to unprotected soft tissues. For this purpose, the TLD was irradiated over a water slab phantom with a photon beam representative of the result of a fluoroscopy beam scattered by a patient. Incident beam angles of 0° and 60°, and lead thicknesses between the TLD and phantom of 0.25 and 0.5 mm Pb were considered. A backscatter correction factor of 1.23 (independent of lead thickness) was calculated comparing the results with those faced in reference conditions (i.e., without lead shield and with an angular incidence of 0°). The corrected dose algorithm was validated in laboratory conditions with dosimeters irradiated over a thyroid collar and angular incidences of 0°, 40° and 60°, as well as with dosimeters worn by interventional radiologists and cardiologists. The corrected dose algorithm provides a better approach to estimate the equivalent dose to unprotected soft tissues such as eye lenses. Dosimeters that are not shielded from backscatter radiation might underestimate personal equivalent doses when worn over a lead apron and, therefore, should be specifically characterized for this purpose.

Contribution of polymorphisms in the LEP, LEPR and RETN genes on serum leptin and resistin levels in young adults from Mexico.

Polymorphisms in the LEP (G-2548A and A19G), LEPR (A326G, A668G and G3057A) and RETN (C-420G and G+62A) genes were documented according to their association with alterations in biochemical parameters such as glucose, insulin and lipid profiles, along with serum leptin and resistin concentrations. The aim of the study was to establish any contribution of the G-2548A and A19G polymorphisms of the LEP gene, the A326G, A668G and G3057A polymorphisms of the LEPR gene, and the C-420G and G+62A polymorphisms of the RETN gene to serum leptin and resistin levels in Mexican young adults. Clinical and biochemical variables, serum leptin and resistin levels, and genotype profiles were analysed in 66 Mexican young adults. Seven polymorphisms in the LEP, LEPR and RETN genes were genotyped using polymerase chain reaction-restriction fragment length polymorphisms analysis. Individuals carrying allele 3057A of the G3057A polymorphism in the LEPR gene showed significantly higher leptin concentrations than those bearing the genotype G/G (43.78 ± 39.11 vs 28.20 ± 14.12 ng/mL; p = 0.021). There were no associations of serum leptin or resistin levels according to the genotype of the other six analysed polymorphisms. Our results suggest that the allele 3057A of the LEPR G3057A polymorphism contributes to increased serum leptin levels in Mexican young adults.

Speciation analysis of organoarsenic compounds in livestock feed by microwave-assisted extraction and high performance liquid chromatography coupled to atomic fluorescence spectrometry.

The development of a new method to determine the presence of the organoarsenic additives p-arsanilic acid (ASA), roxarsone (ROX) and nitarsone (NIT) in livestock feeds by high performance liquid chromatography coupled to ultraviolet oxidation hydride generation atomic fluorescence spectrometry (HPLC-UV/HG-AFS) after microwave assisted extraction (MAE) was proposed. Chromatographic separation was achieved on a C18 column with 2% acetic acid/methanol (96:4, v/v) as the mobile phase. The limits of detection (LODs) were 0.13, 0.09 and 0.08mgL-1, and the limits of quantification (LOQs) were 0.44, 0.30 and 0.28mgL-1. The relative standard deviations (RSDs) for ASA, ROX and NIT determined from five measurements of the mixed calibration standard were 3.3, 5.3, and 5.4%, respectively. MAE extraction of phenylated arsenic compounds using 1.5M H3PO4 at 120°C for 45min allowed for maximum recoveries (%) of total arsenic (As) and organoarsenic species, with no degradation of these compounds. The extraction of total As was approximately 97%, and the As species recoveries were between 95.2 and 97.0%. The results of the analysis were validated using mass balance by comparing the sum of extracted As with the total concentration of As in the corresponding samples. The method was successfully applied to determine the presence of these compounds in feed samples. ASA was the only As species detected in chicken feed samples, with a concentration between 0.72 and 12.91mgkg-1.

Evidence-based guides in tracheostomy use in critical patients

Objetivos: Proporcionar guías de traqueostomía para el paciente crítico, basadas en la evidencia científica disponible, y facilitar la identificación de áreas en las cuales se requieren mayores estudios. Métodos: Un grupo de trabajo formado con representantes de 10 países pertenecientes a la Federación Panamericana e Ibérica de Sociedades de Medicina Crítica y Terapia Intensiva y a la Latin American Critical Care Trial Investigators Network(LACCTIN) desarrollaron estas recomendaciones basadas en el sistema Grading of Recommendations Assessment, Development and Evaluation (GRADE). Resultados: El grupo identificó 23 preguntas relevantes entre las 87 preguntas planteadas inicialmente. En la búsqueda inicial de la literatura se identificaron 333 estudios, de los cuales se escogieron un total de 226. El equipo de trabajo generó un total de 19 recomendaciones: 10 positivas (1B = 3, 2C = 3, 2D = 4) y 9 negativas (1B = 8, 2C = 1). En 6 ocasiones no se pudieron establecer recomendaciones. Conclusión: La traqueostomía percutánea se asocia a menor riesgo de infecciones en comparación con la traqueostomía quirúrgica. La traqueostomía precoz solo parece reducir la duración de la ventilación mecánica pero no la incidencia de neumonía, la duración de la estancia hospitalaria o la mortalidad a largo plazo. La evidencia no apoya el uso de broncoscopia de forma rutinaria ni el uso de máscara laríngea durante el procedimiento. Finalmente, el entrenamiento adecuado previo es tanto o más importante que la técnica utilizada para disminuir las complicaciones.(AU)

OBJECTIVES: Provide evidence based guidelines for tracheostomy in critically ill adult patients and identify areas needing further research. METHODS: A task force composed of representatives of 10 member countries of the Pan-American and Iberic Federation of Societies of Critical and Intensive Therapy Medicine and of the Latin American Critical Care Trial Investigators Network developed recommendations based on the Grading of Recommendations Assessment, Development and Evaluation system. RESULTS: The group identified 23 relevant questions among 87 issues that were initially identified. In the initial search, 333 relevant publications were identified of which 226 publications were chosen. The task force generated a total of 19 recommendations: 10 positive (1B=3, 2C=3, 2D=4) and 9 negative (1B=8, 2C=1). A recommendation was not possible in six questions. CONCLUSION: Percutaneous techniques are associated with a lower risk of infections compared to surgical tracheostomy. Early tracheostomy only seems to reduce the duration of ventilator use but not the incidence of pneumonia, the length of stay, or the long-term mortality rate. The evidence does not support the use of routine bronchoscopy guidance or laryngeal masks during the procedure. Finally, proper prior training is as important or even a more significant factor in reducing complications than the technique used.(AU)